Provider Demographics
NPI:1841653334
Name:MILLER, CARISSA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CREAMERY RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 CREAMERY RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5271
Practice Address - Country:US
Practice Address - Phone:845-242-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY643357163W00000X
NC355400363LF0000X
CT7238363LF0000X
CA95010836363LF0000X
NY341577363LF0000X
NC5019781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC355400OtherNCBON RN LICENSE
NC5019781OtherNCBON NP LICENSE
NY341577OtherNURSE PRACTITIONER
CT7238OtherNURSE PRACTITIONER